Evaluation of long-term outcomes of functional suprahyoid neck dissection in patients with early-stage lower lip cancer.

OBJECTIVE

This study evaluated long-term oncologic outcomes of functional suprahyoid neck dissection (FSND) in patients with early-stage (T1-T2 N0) lower lip squamous cell carcinoma.

METHODS

A retrospective analysis was performed of patients treated surgically for early-stage lower lip cancer at a tertiary center between 1996 and 2023. A total of 107 patients with T1-T2 clinically N0 disease who underwent FSND and had 24 months follow-up were included. Cervical evaluation consisted of physical examination and ultrasonography. Tumors were staged according to the AJCC 2010 criteria. Histopathologic findings, occult metastasis, recurrence, and oncologic outcomes were analyzed.

RESULTS

The cohort consisted of 102 men (95.3%) and 5 women (4.7%), with a mean age of 61.3 years. Tumor stage was T1 in 59.8% and T2 in 40.2% of patients. A total of 146 FSND procedures were performed, including 68 unilateral and 39 bilateral dissections. Occult metastasis was detected in 1.86% of cases. Two patients with histopathologically confirmed N0 disease developed level I nodal recurrence during follow-up; both achieved locoregional control with salvage surgery and/or adjuvant therapy. No FSND-related mortality was observed. Recurrence rates were comparable to those reported for classical suprahyoid and other neck dissection techniques.

CONCLUSION

Although a wait-and-see approach may be appropriate for selected patients with early-stage lower lip cancer, management of the clinically N0 neck remains controversial. Ultrasonography-guided surveillance is effective in patients compliant with close follow-up, whereas FSND represents a safe and reliable option for higher-risk patients or those with limited follow-up compliance, providing accurate staging without compromising oncologic safety.